A cognitive-behavioral therapy (CBT) program for PTSD was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers. CBT was compared to treatment as usual (TAU) in a randomized controlled trial with 108 clients with PTSD and either major mood disorder (85%) or schizophrenia or schizoaffective disorder (15%), of whom 25% also had borderline personality disorder. Eighty-one percent of clients assigned to CBT participated in the program. Intent-to-treat analyses showed that CBT clients improved significantly more than clients in TAU at blinded post-treatment and 3-and 6-month follow-up assessments in PTSD symptoms, other symptoms, perceived health, negative trauma-related beliefs, knowledge about PTSD, and case manager working alliance. The effects of CBT on PTSD were strongest in clients with severe PTSD. Homework completion in CBT predicted greater reductions in symptoms. Changes in trauma-related beliefs in CBT mediated improvements in PTSD. The findings suggest that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations. Keywordsposttraumatic stress disorder; severe mental illness; cognitive behavioral therapy; mood disorder; schizophrenia People with severe mental illnesses such as schizophrenia, bipolar disorder, and treatmentrefractory major depression are more likely to have experienced adverse events in childhood such as sexual and physical abuse, and to be victimized in adulthood, compared to the general population (Bebbington et al., 2004;Goodman, Rosenberg, Mueser, & Drake, 1997;Shevlin, Dorahy, & Adamson, 2007). As a presumed result of this high vulnerability to trauma, surveys of posttraumatic stress disorder (PTSD) in treatment samples of people with prolonged and severe mental illness have reported rates of current PTSD ranging between 29% and 48% (Calhoun et al., 2007;Cascardi, Mueser, DeGiralomo, & Murrin, 1996;Craine, Henson, Colliver, & MacLean, 1988;Howgego et al., 2005;Mueser et al., 1998;Mueser et al., 2001;Mueser et al., 2004c;Switzer et al., 1999). These rates far exceed the prevalence of PTSD in the general population, estimated to be 3.5% over 12-months (Kessler, Chiu, Demler, & Walters, 2005b) and 7 to 12% over the lifetime (Breslau, Davis, Andreski, & Peterson, 1991;Breslau, Peterson, Poisson, Schultz, & Lucia, 2004;Kessler et al., 2005a;Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995;Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993).Persons with severe mental illness may experience psychotic distortions or delusions with themes involving sexual or physical abuse (Coverdale & Grunebaum, 1998), raising questions about the reliability and validity of self-reports of trauma and PTSD in this population. However, research addressing this question supports the validity of self-reports (Read, van Os, Morrison, & Ross, 2005). Self-reports of trauma in clients with severe mental illness are reliable over ...

The associations of perpetration and betrayal with PTSD, controlling for danger-based combat events, highlight the limitations of conceptualizations and treatments of PTSD based on fear or helplessness as sole etiologic factors. (PsycINFO Database Record

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Two experiments examined the role of cognitive inflexibility and reduced working memory in age-related declines on the Wisconsin Card Sorting Test. Both standard scoring procedures and newly developed scores were used to measure each construct, and modifications of the test further evaluated the role of working memory. Results indicated that age differences are not due to cognitive inflexibility but that for a subset of older adults errors are associated with a reduction in the amount of information that can be stored or processed in working memory. These age differences disappear, however, when visual cues provide information about the immediately preceding sort. The authors conclude by proposing a decline in updating working memory as the explanation that can best account for the entire pattern of age differences on this test.

Posttraumatic stress disorder (PTSD) typically follows an acute to chronic course. However, some trauma victims do not report significant symptoms until a period of time has elapsed after the event. Although originally dismissed as an artifact of retrospective methodologies, recent prospective studies document apparent instances of delayed-onset PTSD. Little is known currently about factors associated with the delayed onset of PTSD. This study was designed to examine the course of PTSD in a sample of 1,040 U.S. military peacekeepers who served in Somalia. A small but nontrivial subset of participants endorsed clinically significant levels of PTSD after a period of minimal distress, the magnitude of which cannot be ascribed to minor waxing and waning of symptoms. War-zone exposure and perceived meaningfulness of the mission, as rated by soldiers after returning to the United States, predicted symptom course over the next 18 months.

The challenges of peacekeeping place individuals at risk for the development of significant psychological distress (e.g., B. T. Litz, S. Orsillo, M. Freidman, P. Ehlich, & A. Batres, 1997). Self-disclosure has been shown to ameliorate psychological distress following exposure to potentially traumatic events (J. W. Pennebaker & K. D. Harber, 1993). Sharing, or self-disclosure of deployment-related experiences, was the focus of this study and was hypothesized to be associated with adaptation. As part of a larger investigation, 426 U.S. military personnel who served as peacekeepers in Somalia were administered a comprehensive psychosocial questionnaire that included measures of exposure to negative and potentially traumatic experiences, reception at homecoming, self-disclosure, and PTSD symptom severity. The results indicate that adjustment to peacekeeping is significantly related to self-disclosure, especially to supportive significant others.

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Amnesic patients generally exhibit spared priming effects on implicit memory tasks despite poor explicit memory. In a previous study, we demonstrated normal auditory priming in amnesic patients on an identification-in-noise test in which the magnitude ofpriming is independent of whether the speaker's voice is the same or different at study and test. III the present experiment, we examined auditory priming on a filter identification test in which the magnitude ofpriming in control subjects is higher when the speaker's voice is the same at study and test than when it is different, Amnesic patients, by contrast, failed to exhibit more printing ill a same-voice condition than in a different-voice condition. Voice-specific priming may depend on a memory system that is impaired ill amnesia.